Boniel T, Dannon P
Pharmaceutical Service, Sheba Medical Center, Tel-Hashomer, Ramat-Gan.
Harefuah. 2001 Aug;140(8):780-3, 805.
The use of alternative medicines is increasing world-wide and in Israel. These drugs, considered by the Ministry of Health as food supplements, are to be obtained at pharmacies and health stores and are being sold freely, without any professional advice. Many of the herbs are used by patients to treat psychiatric disorders. These herbs have a pharmacological activity, adverse effects and interactions with conventional drugs, which can produce changes in mood, cognition, and behavior. We present the most commonly used herbal drugs, and discuss their safety and efficacy in psychiatric practice. Hypericum--used as an antidepressant and as an antiviral medicine, was reported in 23 randomized clinical trials reviewed from the MEDLINE. It was found to be significantly more effective than placebo and had a similar level of effectiveness as standard antidepressants. Recent studies almost clearly prove that this herb, like most of the conventional antidepressants, can induce mania. Valerian--is used as an anti-anxiety drug, and reported to have sedative as well as antidepressant properties. In contrast to the significant improvement in sleep that was found with the use of valerian, compared to placebo, there are several reports on the valerian root toxicity. This includes nephrotoxicity, headaches, chest tightness, mydriasis, abdominal pain, and tremor of the hands and feet. Ginseng--another plant that is widely used as an aphrodisiac and a stimulant. It has been associated with the occurrence of vaginal bleeding, mastalgia, mental status changes and Stevens-Johnson syndrome after it's chronic administration. It has interactions with digoxin, phenelzine and warfarin. Ginkgo--in clinical trials the ginkgo extract has shown a significant improvement in symptoms such as memory loss, difficulties in concentration, fatigue, anxiety, and depressed mood. Long-term use has been associated with increased bleeding time and spontaneous hemorrhage. Ginkgo should be used cautiously in patients receiving aspirin, NSAIDs, anticoagulants or other platelet inhibitors. Health care professionals can no longer ignore the widespread use of alternative medicines and cannot continue with the "don't ask, don't tell" policy. Clinicians should ask the patients about their use of herbs in a non-judgmental way, and should document the patient's use of these drugs. Finally, we must be more aware of the side effects and the potential drug interactions of these herbs, and advise our patients to avoid long term use of these drugs due to lack of information regarding the safety of these medicines.
在全球范围内以及以色列，替代药物的使用正在增加。这些药物被卫生部视为食品补充剂，可在药店和健康商店购得，且可自由售卖，无需任何专业建议。许多草药被患者用于治疗精神疾病。这些草药具有药理活性、副作用以及与传统药物的相互作用，可能会导致情绪、认知和行为的变化。我们介绍最常用的草药药物，并讨论它们在精神科实践中的安全性和有效性。金丝桃——用作抗抑郁药和抗病毒药，在MEDLINE检索的23项随机临床试验中有相关报道。结果发现它比安慰剂显著更有效，且与标准抗抑郁药的有效性水平相似。近期研究几乎明确证明，这种草药与大多数传统抗抑郁药一样，可诱发躁狂。缬草——用作抗焦虑药物，据报道具有镇静以及抗抑郁特性。与使用缬草相比安慰剂在改善睡眠方面有显著效果不同，有几篇关于缬草根毒性的报道。这包括肾毒性、头痛、胸闷、瞳孔散大、腹痛以及手脚震颤。人参——另一种被广泛用作壮阳药和兴奋剂的植物。长期服用后，它与阴道出血、乳房疼痛、精神状态改变以及史蒂文斯 - 约翰逊综合征的发生有关。它与地高辛、苯乙肼和华法林存在相互作用。银杏——在临床试验中，银杏提取物在改善诸如记忆力减退、注意力不集中、疲劳、焦虑和情绪低落等症状方面显示出显著效果。长期使用与出血时间延长和自发性出血有关。在接受阿司匹林、非甾体抗炎药、抗凝剂或其他血小板抑制剂治疗的患者中应谨慎使用银杏。医疗保健专业人员不能再忽视替代药物的广泛使用，也不能继续奉行“不问不说”的政策。临床医生应以无偏见的方式询问患者使用草药的情况，并应记录患者使用这些药物的情况。最后，我们必须更加了解这些草药的副作用和潜在药物相互作用，并建议我们的患者由于缺乏关于这些药物安全性的信息而避免长期使用这些药物。
